Provider First Line Business Practice Location Address:
531 S 29TH ST STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT DODGE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50501-5503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-302-8072
Provider Business Practice Location Address Fax Number:
949-862-3765
Provider Enumeration Date:
06/15/2011